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14 March 2013
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Challenging Doctor's Beliefs

Challenging Doctor’s Current Beliefs in Order to Improve Services

We’ve all heard the clichés – the population is getting sicker, older and more expensive to take care of. Politicians, healthcare professionals and managers have all been scratching their heads as to how to provide healthcare fit for the 21st Century without upsetting voters and patients. Change has not been fast or radical enough. It is time that the healthcare systems throughout the world took the old rules they have followed about healthcare provision and challenged them in order to provide the best care possible. This needs to happen fast, before health services collapse under their own weight and the quality of patient care deteriorates as a result of the inevitable naval-gazing that accompanies the bitter reactions of vested interests when change within a profession is proposed.

As The Economist magazine reported in June 2012, 21st Century Medicine will be different from 20th Century Medicine. The Economist attributed this to the ‘impossible numbers’ of doctors required to provide a 20th Century model of care throughout the world, based on the current expected ratio of doctors per head of population1. The Economist portrayed a rather negative future – one where doctors would be squeezed out of health provision. But, rather than the negative perspective given on the role of doctors in this regard by The Economist  - the ‘squeezing out’ of doctors in the new century – doctors can in fact play a key role in developing the new breed of health care system where there are currently too few doctors for too many patients. 

Doctors may have to accept that legislation will inevitably be passed that puts limits on the privileged position the profession has previously enjoyed. It is likely that nurses and other healthcare professionals will play an even bigger role in future, taking on more tasks, such as prescribing and advising, that were previously the domain of doctors. Doctors will focus on the most complicated and challenging of tasks and the care of the most ill patients in the hospital. The most challenging of tasks may not have anything to do with an individual patient but with the bigger picture of healthcare provision.

If an erosion of status is accepted as an inevitable result of more centralised healthcare systems attempting to reduce costs, then progress can be made. Whilst there is opposition to this, there will be no advancement in making the necessary long-term improvements now. There will be a risk that changes will be forced upon healthcare systems, shaped by circumstance rather than the best interests of patients. In such a scenario doctors will have no choice other than to accept uncoordinated and rushed changes, missing out on the opportunity to help shape healthcare services.

Doctors have often been divorced from management and leadership issues, instead allowing non-clinical business graduates to direct the provision of services. Generic management is acceptable if applied to certain areas of health-services management, such as Human Resources Management where broad skills can be applied in almost any industry. When it comes to service delivery it is those on the front line who must be involved in making decisions. Their opinion on how to divide scarce resources, change systems within hospitals or rearrange the patient journey in order to provide the best patient care is vital in improving the outcomes of the system.

Top-down directed change is rarely successful and is viewed by those who have to work within the system as an assortment of commands from individuals who are out of touch with the realities of the working environment. Take the many reorganisations of the NHS by politicians. Doctors must therefore step up to the plate, take up the reins of healthcare provision and put themselves forward to drive forward change for the good of their patients.

1)      Bangalore and Framingham. Squeezing out the Doctor. The Economist. 2nd June 2012. Available online at:

Adam Dalby, Think Tank Lead, Medical Student Group, FMLM

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About the author

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Originally from East Yorkshire, Dr Adam Dalby is a holder of the MB BCh BAO degrees from The Queen’s University of Belfast. He graduated from Imperial College London in 2011 with a BSc in Medical Sciences with Management, following his group project exploring the importance of networking in General Practice in providing high quality patient care.

Dr Dalby is the Founder of the Queen’s Healthcare Leadership Forum ( a student society at Queen’s dedicated to increasing the interest and involvement of student healthcare practitioners in the improvement and leadership of healthcare services. He believes passionately that those working on the front-line are able to best improve healthcare services for patients and that junior staff must be empowered to innovate by senior staff in order to modernise the health service.


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